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关注brolucizumab对息肉状脉络膜血管病变的治疗作用及其临床应用
刘璟瑶
刘勃实
李筱荣
作者及单位信息
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DOI: 10.3760/cma.j.cn115989-20230315-00087
Paying close attention to the therapeutic effect of brolucizumab on polypoidal choroidal vasculopathy and its clinical application
Liu Jingyao
Liu Boshi
Li Xiaorong
Authors Info & Affiliations
Liu Jingyao
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Liu Boshi
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Li Xiaorong
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
·
DOI: 10.3760/cma.j.cn115989-20230315-00087
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摘要

息肉状脉络膜血管病变(PCV)好发于中老年人群,主要临床特征为脉络膜内异常血管形态,如分支状脉络膜血管网和血管末端息肉样扩张,视网膜下橘红色结节样病变及出血性或浆液性视网膜色素上皮脱离(PED),易造成视网膜出血或玻璃体积血,是主要致盲眼底病变之一。抗血管内皮生长因子(VEGF)药物玻璃体内注射是目前PCV治疗的主要方法,在消除异常血管网和清除息肉样病灶、减轻血管渗出及促进渗出液吸收、改善视力预后方面具有一定的优势,但频繁的玻璃体内药物注射增加了感染的风险,也增加患者的治疗负担。此外,治疗后的高复发率也给临床实践带来了巨大挑战,因此寻求药效持久且经济负担较轻的新型治疗药物是PCV临床研究关注的焦点。brolucizumab是一种新型小分子抗VEGF类人源化单抗药物,具有组织穿透性强、局部药物浓度及生物利用度高、注射剂量小、药效持久和注射间隔时间长等优势,为PCV的临床治疗及患眼预后改善带来了新的希望。目前虽然有较多文献证实了brolucizumab治疗PCV的疗效和安全性,但文献多来自于日本、印度和韩国,仍然缺乏中国的临床实践数据。随着该药物在多个国家的批准上市,相信在不久的将来该治疗方法可惠及更多的PCV患者。我国的眼科医师和研究者应密切关注brolucizumab在PCV治疗中的研究进展。

布西珠单抗;息肉状脉络膜血管病变;血管内皮生长因子;玻璃体内注射;治疗用途
ABSTRACT

Polypoidal choroidal vasculopathy (PCV) occurs in the middle-aged and elderly population and is characterized by abnormal intrachoroidal vascular patterns such as branching choroidal vascular networks and polypoidal dilatation of vessel terminals, subretinal orange nodular lesions and hemorrhagic or plasma retinal pigment epithelial detachment (PED), which can cause retinal hemorrhage or vitreous hematopoiesis and is one of the major blinding fundus lesions.Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs is currently the main method of PCV treatment, and has certain advantages in eliminating abnormal vascular networks and removing polypoidal lesions, reducing vascular exudation and promoting exudate absorption, and improving visual prognosis.However, frequent intravitreal drug injections increase the risk of infection and the treatment burden for patients.In addition, the high recurrence rate after treatment poses a significant challenge to clinical practice, so the search for new therapeutic agents that are durable and less costly is a focus of clinical research in PCV.The literature from abroad suggests that brolucizumab is a novel small-molecule anti-VEGF humanized monoclonal antibody with the advantages of high tissue penetration, high local drug concentration and bioavailability, small injectable dose, long-lasting efficacy and long injection interval, which brings new hope for the clinical treatment of PCV and improving the prognosis of affected eyes.Although the efficacy and safety of brolucizumab in the treatment of PCV have been well documented, the literature is mainly from Japan, India and Korea, and clinical practice data from China are still lacking.With the approval of the drug in several countries, it is believed that more PCV patients could benefit from this treatment in the near future.Ophthalmologists and researchers in China should closely follow the progress of brolucizumab in the treatment of PCV.

Brolucizumab;Polypoidal choroidal vasculopathy;Vascular endothelial growth factors;Intravitreal injections;Therapeutic uses
Li Xiaorong, Email: mocdef.3ab61ilroaix
引用本文

刘璟瑶,刘勃实,李筱荣. 关注brolucizumab对息肉状脉络膜血管病变的治疗作用及其临床应用[J]. 中华实验眼科杂志,2023,41(07):617-622.

DOI:10.3760/cma.j.cn115989-20230315-00087

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息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)目前属于新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,nAMD)的一种亚型,在亚洲人群中约50%的nAMD为PCV。流行病学统计发现,PCV发病具有性别、年龄倾向,男性和中老年人群更多见 [ 1 , 2 ]。PCV的主要临床特征为脉络膜内异常分支状血管网(branching neovascular network,BNN)、视网膜下橘红色结节样病变(polypoidal lesions,PL)及出血性或浆液性视网膜色素上皮脱离(pigment epithelial detachment,PED),是造成患者不可逆视力损害甚至盲的主要原因,其主要治疗目标在于消退息肉样病灶,抑制脉络膜新生血管的形成以及渗漏 [ 2 , 3 ]。血管内皮生长因子(vascular endothelial growth factor,VEGF)参与新生血管的形成和维持,因此抗VEGF药物应用成为目前PCV的首选治疗方案。临床常用的抗VEGF药物包括雷珠单抗、阿柏西普、康柏西普等玻璃体内注射用生物制剂,对新生血管形成的抑制作用效果显著。然而,尽管多数患者治疗后病情有所改善,但病变易复发,加之常用抗VEGF药物普遍价格偏高、作用时效偏短及注射次数偏多等问题,大大降低了患者治疗的依从性,给疾病的进展及结局的有效控制带来很大挑战。因此,减少玻璃体内药物注射次数和降低经济负担是PCV新型治疗药物研发的焦点。brolucizumab为一种近期研发的nAMD治疗生物制剂,目前已用于湿性年龄相关性黄斑变性以及糖尿病性黄斑水肿等疾病的治疗。2项关于brolucizumab治疗nAMD的Ⅲ期临床试验(HAWK和HARRIER)结果显示,与阿柏西普比较,brolucizumab能有效促进RPE下渗出液的吸收 [ 4 ]。结合现有临床实践及循证医学证据,brolucizumab治疗PCV具有一定的临床效果,为PCV的有效治疗带来了新的希望。
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